CONTRIBUTION OF CHRONIC CONDITIONS TO MORTALITY: DIFFERENCES BY RACE AND ETHNICITY

Abstract Health disparities exist in the timing, order, and accumulation of chronic somatic and neurodegenerative conditions, which are associated with increased health care utilization, expenditure, and mortality. We assessed the contribution of coexisting conditions to mortality among Hispanic, non-Hispanic (NH) White, and NH Black older adults in the United States to measure their burden. We used nationally-representative data from the Health and Retirement Study (HRS) from 1998-2016 (n=11,532). This analysis estimates the absolute additive contributions of seven somatic and two mental/neurodegenerative conditions using a longitudinal average attributable fraction derived from a survey-weighted multivariable discrete survival model adjusted for sociodemographic characteristics (sex, education, net worth, body-mass index, coupled, insured, and any of six ADLs lasting three or more months “because of physical, mental, emotional, or memory problems”). Conditions accounted for over 60% of mortality in each racial/ethnic group (64.0%, 62.2%, and 70.5% in Hispanic, NH White, and NH Black adults, respectively). Although we found that cardiovascular diseases (heart disease and hypertension) were the greatest contributor to morality in each racial/ethnic group, the impact of other conditions varied by race/ethnicity. Leading contributors to mortality were diabetes (12.0%) and dementia (7.2%) for Hispanic participants; cancer (13.0%) and lung disease (10.7%) for NH White participants; and diabetes (11.5%), lung disease (7.4%), and dementia (7.3%) in NH Black participants. This study provides insights into racial and ethnic differences in the contribution of chronic somatic and neurodegenerative conditions to mortality and may help target efforts for specific preventative care services to populations most impacted by them.


BRAIN HEALTH COMMUNITY REGISTRY: DEVELOPMENT OF A MODEL FOR CONNECTING PARTICIPANTS TO COMMUNITY-BASED SUPPORTS
Laura Block 1 , Meghan Haas 1 , Lilli Kay 1 , Clark Benson 2 , and Andrea Gilmore-Bykovskyi 1 , 1. University of Madison,Wisconsin,United States,2. University of Wisconsin School of Medici,Madison,Wisconsin,United States Growing evidence demonstrates social and economic factors (e.g.socioeconomic status, level of education) contribute to risk for Alzheimer's disease and related dementia (ADRD).These factors also serve as barriers to research participation, contributing to systematic under-inclusion in ADRD research.The Participant and Relationship-Oriented Research Engagement (PRORE) Model outlines mechanisms through which socioeconomic determinants and reciprocal relationships may shape research participation; however, scalable protocols that address these mechanisms are lacking.Our objective was to develop and pilot the feasibility and acceptability of a research-based resource-matching protocol.The Brain Health Community Registry (BHCR) recruits adults ages 40 and above with and without changes in memory, and caregivers of individuals experiencing memory changes.BHCR connects participants with research opportunities and conducts a needs assessment to match individuals with community-based services and supports.Of 168 participants enrolled in BHCR, 33 (20%) report changes in memory, 93 (55%) do not, and 42 (25%) are caregivers.More than half (n=91, 58%) requested resource matching.Resource matching took 1.8 hours per participant (range 0.5-4.5 hours).Challenges included navigating rural counties with limited resources and effective follow-up; strategies included an interdisciplinary approach, offering multiple modes of contact, and a strengths and relation-based approach.Participants who responded to follow-up at two and six weeks (45% of total), and at annual review (100%, N=6) described resource-matching as instrumental for successful connection to supports, general knowledge/preparation, or on behalf of a friend or family member.Future work must ascertain whether needs assessment and resource matching change study participant perceptions of research.Health disparities exist in the timing, order, and accumulation of chronic somatic and neurodegenerative conditions, which are associated with increased health care utilization, expenditure, and mortality.We assessed the contribution of coexisting conditions to mortality among Hispanic, non-Hispanic (NH) White, and NH Black older adults in the United States to measure their burden.We used nationallyrepresentative data from the Health and Retirement Study (HRS) from 1998-2016 (n=11,532).This analysis estimates the absolute additive contributions of seven somatic and two mental/neurodegenerative conditions using a longitudinal average attributable fraction derived from a surveyweighted multivariable discrete survival model adjusted for sociodemographic characteristics (sex, education, net worth, body-mass index, coupled, insured, and any of six ADLs lasting three or more months "because of physical, mental, emotional, or memory problems").Conditions accounted for over 60% of mortality in each racial/ethnic group (64.0%, 62.2%, and 70.5% in Hispanic, NH White, and NH Black adults, respectively).Although we found that cardiovascular diseases (heart disease and hypertension) were the greatest contributor to morality in each racial/ethnic group, the impact of other conditions varied by race/ethnicity.Leading contributors to mortality were diabetes (12.0%) and dementia (7.2%) for Hispanic participants; cancer (13.0%) and lung disease (10.7%) for NH White participants; and diabetes (11.5%), lung disease (7.4%), and dementia (7.3%) in NH Black participants.This study provides insights into racial and ethnic differences in the contribution of chronic somatic and neurodegenerative conditions to mortality and may help target efforts for specific preventative care services to populations most impacted by them.

EDUCATION AS A MEDIATOR OF GENDER DIFFERENCES IN COGNITION IN OLDER ADULTS
Judith Rijnhart 1 , Matthew Valente 1 , Almar Kok 2 , and Martijn Huisman 2 , 1. University of South Florida, Tampa, Florida, United States, 2. Amsterdam University Medical Center, Amsterdam, Noord-Holland, Netherlands Although dementia is more prevalent in women than in men, studies on the socio-cultural mechanisms that cause and sustain gender differences in dementia remain scarce.Historic gender differences in education may explain why older women are at higher risk of dementia nowadays.This study aimed to investigate education as a mediator of gender differences in cognitive function, as measured with the Mini-Mental State Examination (MMSE).We used data from the Longitudinal Aging Study Amsterdam.The analytical sample consisted of 2,909 older adults aged 55-85, of whom 1,601 were women and 1,506 were men.We used causal mediation analysis to estimate total, indirect, and direct effects of gender on MMSE.Effect estimates were adjusted for confounding by age, parental education, and childhood adversity.The total effect was -0.60 (95% CI: -0.90; -0.32), indicating that women on average had a 0.60 lower MMSE score than men.The indirect effect was -0.84 (95% CI: -1.11; -0.59), indicating that women on average had a 0.84 lower MMSE score compared to men, because women completed fewer years of education.The direct effect was 0.24 (95% CI: 0.04; 0.44), indicating that if women had the same number of education years as men, their MMSE score would on average be 0.24 points higher than the average MMSE score in men.These findings indicate that education is an important mediator of gender differences in cognitive function.Future studies are needed to explore whether gender differences in cognitive function decrease as gender equality in education increases.

HOW THE PATIENT-CENTERED MEDICAL HOME MODEL IMPACTS OLDER ADULTS' ACCESS TO HEALTH CARE IN RURAL GEORGIA
Elisa Childs, University of Iowa, Iowa City, Iowa, United States Rural Americans face several healthcare access barriers, including limited providers and driving further distances to receive care.Georgia healthcare access is especially problematic given its high rurality, hospital closure rate, number of medically underserved areas, and older adult population.The government promotes the Patient-Centered Medical Home (PCMH) model to improve healthcare access.This study supports a better understanding of older Georgian's access to care by exploring PCMH's ability to improve healthcare access.Older adults were surveyed using a modified version of the Healthcare Quality Survey (N=746).Analyses included univariate, bivariate (t-test, ANOVA, chi-square, and a crosstabulation), and multivariate (multiple linear regression).Healthcare access was statistically significantly different depending on care source type, with significant associations between PCMH users and income, age, urban/rural status, and health status.Access was also statistically significantly different based on annual household income, educational attainment, age, and health status.Further, a significant relationship was found between access and age, income, and health status.PCMH users were primarily Caucasian and most often had an advanced degree and income of $60,000 or more.PCMH users most often reported living in Three Rivers, Atlanta Region, Northeast Georgia, and the Georgia Mountains.Finally, urban and rural residents with a regular care source reported "always" receiving needed care more often than PCMH users and those with no care source.The National Committee for Quality Assurance and other accreditation agencies should target low-income rural areas with high older adult populations when implementing the PCMH model to increase older adults' healthcare access.

MALE BREAST CANCER IN OLDER ADULTS BELONGING TO THE LOWER-INCOME GROUP Esha Chakravarty, Calcutta Metropolitan Institute of Gerontology, Mitcham, England, United Kingdom
Male breast cancer is a rare type of cancer constituting around 1% of male malignancies.Cases of 21 elderly (aged>60) patients diagnosed with breast cancer were studied with respect to age of onset, treatment choices, access to care, ability to perform activities of daily living (ADL) from CMIG, resource centre on ageing in east India.All 21 patients belonged to lower income group in society and the study was conducted over a 5 year period of 2018-2022.Primary symptom leading to diagnosis was self-detection of lump and the median time of diagnosis from onset of symptoms was 6 months.Twenty of the 21 patients were diagnosed with Stage III or Stage IV breast cancer and 1 patient was diagnosed with Stage I cancer.The average age of diagnosis of the patients was found to be 69 years.The main method of treatment was surgery for patient diagnosed in Stage I and

CONTRIBUTION OF CHRONIC CONDITIONS TO MORTALITY: DIFFERENCES BY RACE AND ETHNICITY Ana
Quiñones 1 , Miriam Elman 1 , Gail McAvay 2 , Brent Vander Wyk 2 , Corey Nagel 3 , and Heather Allore 2 , 1. OHSU-PSU School of Public Health, Portland, Oregon, United States, 2. Yale University, New Haven, Connecticut, United States, 3. University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States